Healthcare Provider Details

I. General information

NPI: 1104876390
Provider Name (Legal Business Name): COMMUNITY HEALTH CARE SYSTEMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 SMITH ST
TENNILLE GA
31089-1465
US

IV. Provider business mailing address

2251 W ELM ST
WRIGHTSVILLE GA
31096-2017
US

V. Phone/Fax

Practice location:
  • Phone: 478-552-7384
  • Fax: 478-552-1198
Mailing address:
  • Phone: 478-864-3448
  • Fax: 478-864-1288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MRS. LYNN W PRICE
Title or Position: INSURANCE SUPERVISOR
Credential:
Phone: 478-864-3448